Lakhasly

A sharp blade of the proper size should be used.This detachment results in the formation of a small hematoma increasing postoperative oral swelling, and the organization of the blood clot results in the loss of depth in the buccal sulcus?In addition, torn, split, and macerated tissue heals more slowly than a cleanly reflected full thickness flap Vertical-releasing incisions should cross the free gingival margin at the line angle of a tooth and should not be directly on the facial aspect of the tooth nor directly in the papilla.So, vertical releasing incisions in the posterior aspect of the palate should be avoided, because they usually sever the greater palatine artery within the tissue, which results in bleeding that may be difficult to control.11- The vertical relaxing incision should not extend beyond the depth of the mucobuccal fold to avoid detaching the alveolar attachment of muscles (e.g. buccinator muscle) from the bone.This angle produces squared wound edges that are both easier to re- approximated properly during suturing and less susceptible to necrosis of the wound edges as a result of ischemia, and overlapping of the edges during closure.Because the goal of the surgery is to remove or reshape the bone, all overlying tissue must be reflected from it. In addition, full-thickness flaps are necessary because the periosteum is the primary tissue responsible for bone healing, and replacement of the periosteum in its original position hastens that healing process.8- Incisions should not be made in an area of thinned mucosa e.g. over an exostosis or bony protuberances because the blood supply is reduced, suturing is difficult, and the rate of dehiscence is high.The base of the flap must be broader than the free gingival margin, and width of the base should be greater than the length, to ensure adequate blood supply and to promote healing.If the pathologic condition has eroded the buccocortical plate, the incision must be at least 6 or 8 mm away from it. In addition, if bone is to be removed over a particular tooth, the incision must be sufficiently distant from it so that after the bone is removed, the incision is 6 to 8 mm away from the bony defect created by surgery.If the incision line is unsupported by sound bone, It tends to collapse into the bony defect, which results in wound dehiscence, infection and delayed healing .The flap should be designed to avoid injury to local vital structures in the area of the surgery The greater palatine artery, which emerges from the greater palatine foramen.The nasopalatine nerves and arteries exit the incisive foramen to supply the anterior palatal gingiva.If the anterior palatal tissue must be reflected, both the artery and the nerve can be incised at the level of the foramen without much risk.Incisions that cross the gingival papilla damage the papilla unnecessarily and increase the chances for localized periodontal problems; such incisions should be avoided.A sharp blade allows incisions to be made cleanly, without unnecessary damage caused by repeated strokes.Bone and ligamental tissues dull blades more rapidly than does buccal mucosa.Incisions that cross the free margin of the gingiva directly over the facial aspect of the tooth do not heal properly because of tension; the result is a defect in the attached gingiva.The incisions that outline the flap must be made over intact bone that will be present after the surgical procedure is complete.This means that the flap includes the surface mucosa, submucosa, and periosteum.Because the facial bone is frequently quite thin, such incisions will also result in vertical clefting of the bone.Sharp corners tend to slough because of poor circulation and this causes excessive scarring.?

A sharp blade of the proper size should be used. A sharp blade
allows incisions to be made cleanly, without unnecessary damage
caused by repeated strokes. The rate at which a blade dulls
depends on the resistance of tissues through which the blade cuts.
Bone and ligamental tissues dull blades more rapidly than does
buccal mucosa. Therefore the surgeon should change blades
whenever the knife does not seem to be incising easily.
The flap should be designed to avoid injury to local vital structures in the
area of the surgery
The greater palatine artery, which emerges from the greater
palatine foramen. So, vertical releasing incisions in the posterior
aspect of the palate should be avoided, because they usually sever
the greater palatine artery within the tissue, which results in
bleeding that may be difficult to control.
 The nasopalatine nerves and arteries exit the incisive foramen to
supply the anterior palatal gingiva. If the anterior palatal tissue must
be reflected, both the artery and the nerve can be incised at the level
of the foramen without much risk. The likelihood of bothersome
bleeding is small, and the nerve regenerates quickly. The temporary
numbness usually does not bother the patient.
The incisions that outline the flap must be made over intact bone that will be present
after the surgical procedure is complete. If the pathologic condition has eroded the
buccocortical plate, the incision must be at least 6 or 8 mm away from it. In addition, if
bone is to be removed over a particular tooth, the incision must be sufficiently distant
from it so that after the bone is removed, the incision is 6 to 8 mm away from the bony
defect created by surgery. If the incision line is unsupported by sound bone, It tends to
collapse into the bony defect, which results in wound dehiscence, infection and delayed
healing .
Incisions should be made with the blade held perpendicular to the epithelial surface. This
angle produces squared wound edges that are both easier to re- approximated properly
during suturing and less susceptible to necrosis of the wound edges as a result of ischemia,
and overlapping of the edges during closure.
5- The flap should be a full-thickness mucoperiosteal flap. This means that the flap
includes the surface mucosa, submucosa, and periosteum. Because the goal of the surgery
is to remove or reshape the bone, all overlying tissue must be reflected from it. In
addition, full-thickness flaps are necessary because the periosteum is the primary tissue
responsible for bone healing, and replacement of the periosteum in its original position
hastens that healing process. In addition, torn, split, and macerated tissue heals more slowly
than a cleanly reflected full thickness flap
Vertical-releasing incisions should cross the free gingival margin at the line angle of a tooth
and should not be directly on the facial aspect of the tooth nor directly in the papilla. Incisions
that cross the free margin of the gingiva directly over the facial aspect of the tooth do not heal
properly because of tension; the result is a defect in the attached gingiva. Because the facial
bone is frequently quite thin, such incisions will also result in vertical clefting of the bone.
Incisions that cross the gingival papilla damage the papilla unnecessarily and increase the
chances for localized periodontal problems; such incisions should be avoided.
The MPF should be made large enough to provide for visibility, accessibility and
adequate room for instrumentation.
8- Incisions should not be made in an area of thinned mucosa e.g. over an
exostosis or bony protuberances because the blood supply is reduced, suturing is
difficult, and the rate of dehiscence is high.
The base of the flap must be broader than the free gingival margin,
and width of the base should be greater than the length, to ensure
adequate blood supply and to promote healing.
10- There should be no sharp angles on the flap. Sharp corners tend to
slough because of poor circulation and this causes excessive scarring.
Therefore, the vertical releasing cut should not be made at a sharp angle to
the primary incision but instead in a gentle curve.
11- The vertical relaxing incision should not extend beyond the depth of the
mucobuccal fold to avoid detaching the alveolar attachment of muscles (e.g.
buccinator muscle) from the bone. This detachment results in the formation
of a small hematoma increasing postoperative oral swelling, and the
organization of the blood clot results in the loss of depth in the buccal sulcusح